Provider Demographics
NPI:1194411629
Name:HAIR RESTORATION & AESTHETICS OF BUFFALO
Entity type:Organization
Organization Name:HAIR RESTORATION & AESTHETICS OF BUFFALO
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRACTICE ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:LORI
Authorized Official - Middle Name:
Authorized Official - Last Name:NICHOLAS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:716-870-0437
Mailing Address - Street 1:777 MAPLE RD STE 4&5
Mailing Address - Street 2:
Mailing Address - City:WILLIAMSVILLE
Mailing Address - State:NY
Mailing Address - Zip Code:14221-3275
Mailing Address - Country:US
Mailing Address - Phone:716-500-4247
Mailing Address - Fax:716-428-3890
Practice Address - Street 1:777 MAPLE RD STE 4&5
Practice Address - Street 2:
Practice Address - City:WILLIAMSVILLE
Practice Address - State:NY
Practice Address - Zip Code:14221-3275
Practice Address - Country:US
Practice Address - Phone:716-500-4247
Practice Address - Fax:716-428-3890
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-04-17
Last Update Date:2023-04-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty